Centers Plan for Dual Coverage Care (HMO SNP) was designed to offer those who are eligible, the convenience of combining the benefits of both Medicare and Medicaid into one comprehensive health plan. The plan includes prescription drug coverage.
This section will provide you with all the information you need to get the most out of your Centers Plan for Dual Coverage Care (HMO SNP) benefits.
Welcome to Centers Plan for Healthy Living. As a member, you can expect the quality service you deserve and a program that focuses on your personal healthcare needs, supported by a team of caring health care professionals. We know that for some members the process of enrolling and managing a healthcare plan can be intimidating. Having the right guidance and information can ease the burden and help you, your family and your healthcare provider make the right decisions. This members section is designed to provide you with easy to use, searchable information that other members have found helpful, as they plan for years of healthy living. As a member of the CPHL family, we want to make your healthcare experience as beneficial as possible. We are available to help, so if you should have any questions or feedback on ways to enhance your membership, please call or send us any comments you may have, so that we can continue to improve our plan and make CPHL the program of choice for you.
- You must be enrolled in Medicare Part A and B
- You must be Medicaid eligible
- You must live in our contracted service area (Bronx, Kings, New York, Queens and Richmond Counties)
If you personally paid for a covered medical service or OTC item, fill out this form to receive timely reimbursement:
Member Reimbursement Form (last updated 11/8/16)
Medicare Transition Drug Policy Overview – Last Updated 07/06/2015
Prescription Drug Transition Policy – Last updated 04/18/2014
This document describes Centers Plan for Healthy Living’s (CPHL) process for transitions to ensure that continued drug coverage is provided to new and current Medicare Advantage Part D (MAPD) members.
2017 Prior Authorization Requirements (PAWEB) – Last updated 03/02/2017
2017 Step Therapy Requirements (STEPWEB) – Last updated 03/03/2017
2017 Future Formulary Changes – Last updated 03/03/2017
In the event that you need to appoint a representative regarding a claim the following form is also available on the Medicare and Medicaid Services (CMS) website. CMS Appointment of Representative Form – Last updated 10/20/2014
CMS Electronic Complaint Form – Last updated 11/19/2014
Best Available Evidence (BAE) – Last updated 11/19/2014
Out of Network Coverage Rules
It is Important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which our plan authorizes use of out-of-network providers. For further information see Chapter 3 (Using the plan’s coverage for your medical services) of your Evidence of Coverage using the link on this page.
Centers Plan for Dual Coverage Care (HMO SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2018 based on a review of Centers Plan for Dual Care (HMO SNP) Model of Care
Our friendly and caring member services staff is committed to assisting you and answering all your questions. Whether its regarding your benefits or locating a nearby provider, member services is here to help.
Centers Plan for Healthy Living
75 Vanderbilt Ave
Staten Island, NY 10304
- Contact our member services at 1-877-940-9330 (or TTY number 1-800-421-1220) available 7 days a week, 8AM-8PM (EST) or by email: firstname.lastname@example.org
- Contact our Pharmacy help desk at 1-888-807-5717 available 24 hours a day, 7 days a week
- Contact our Mail Order Prescription at 1-888-552-6694 available Monday through Friday 9:00AM-9:00PM (EST) Saturday from Noon to 5:00pm (EST)